Inequalities in Care Linked to Poor Hospital Payer Mix


Hospital payer mix may be widening inequalities in care for low-socioeconomic status patients, shows a study presented at the 2016 American Academy of Orthopaedic Surgeons annual meeting in Orlando this week.

Hospital payer mix may be widening inequalities in care for low-socioeconomic status patients, according to a new study that finds that hospitals with more patients without insurance, or with Medicare/Medicaid, have a lower volume of total joint arthroplasties.

This low volume is a problem, orthopedic surgeon Anthony Catanzano, M.D., Duke University School of Medicine, and colleagues reported during a presentation on March 1 at the annual meeting of the American Academy of Orthopaedic Surgeons in Orlando, Florida.[[{"type":"media","view_mode":"media_crop","fid":"46415","attributes":{"alt":"©Addyvanich/","class":"media-image media-image-right","id":"media_crop_5709403739310","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5381","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":"©Addyvanich/","typeof":"foaf:Image"}}]]

Hospitals with a higher volume of these surgeries tend to have better outcomes than low-volume hospitals, Dr. Catanzano reported. And low-volume hospitals with high numbers of Medicare/Medicaid patients are susceptible to fines from the Centers for Medicare and Medicaid Services, further stressing their financial viability.

Dr. Catanzano and colleagues used data from the New York Statewide Planning and Research Cooperative System (SPARCS) database to divide hospitals into quartiles representing total joint arthroplasty volume. The dataset covered the years 2000 to 2012.

There was a significant difference in payer mix between all four quartiles, with Medicaid/Medicare and self-pay making up 69 percent of payers in the first (lowest) quartile, 64.7 percent in the second quartile, 59.6 percent in the third quartile and 55 percent in the fourth quartile averaged over the full study period (p<0.05). Volume of total joint arthroplasties varied widely from 16.7 in 2000 and 24.9 in 2012 in the first quartile up to 415.1 in 2000 and 979.2 in 2012 in the fourth quartile. In the 13 years studied, the number of hospitals performing total joint arthroscopies dropped from 207 to 178, but the total number of surgeries increased from 33,036 to 62,104.

"Our study demonstrates that higher volume hospitals tended to have a more favorable payer mix," the researchers wrote in their meeting abstract, adding that the inequality between low- and high-volume centers widened with time. The trend may threaten both the sustainability of hospitals with high proportions of uninsured and Medicare/Medicaid patients and access to quality care for low-income patients, they concluded.




"The Relationship Between Hospital Payer Mix and Volume Growth in Total Joint Arthroplasty,"

American Academy of Orthopaedic Surgeons, 2016 Annual Meeting. March 1, 2016. Anthony A. Catanzano, M.D., Durham, North Carolina. 

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